Corticotropin-independent Cushing's syndrome in patients with bilateral adrenal masses

To present our institutional experience in the patients with ACTH-independent Cushing's syndrome treated for bilateral adrenal masses during the past 8 years. Bilateral adrenal masses are rare in patients with adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome.

A retrospective review of 11 patients with ACTH-independent Cushing's syndrome of bilateral adrenal masses was performed. Bilateral adrenalectomy or bilateral/unilateral partial adrenalectomy was made for these patients. The steroid replacement was discontinued after 6-12 months postoperatively, and the follow-up information was obtained to evaluate the disease outcome.

Combining ultrasonography and computed tomography scan with biochemical tests, 6 cases of bilateral adrenal adenomas and 5 cases of ACTH-independent macronodular adrenal hyperplasia (AIMAH) were diagnosed. The median follow-up time was 13 months (range, 9-22). For all patients, both systolic (181 ± 17 vs 145 ± 11 mm Hg; P <.001) and diastolic blood pressure levels (118 ± 13 vs 88 ± 11 mm Hg; P <.001) were significantly reduced postoperatively. The body mass index significantly decreased (28.0 ± 2.4 vs 24.6 ± 1.3 kg/m(2); P <.001). After bilateral adrenalectomy, glucocorticoid therapy was enough to maintain the balance of water and electrolytes metabolism, and the follow-up outcome showed no disorder of serum electrolytes metabolism.

Although a feasible method is still needed for determining the lateralization of cortisol secretion of bilateral adrenal masses, ultrasonography and computed tomography scan are useful for the diagnosis and differentiated diagnosis of AIMAH. Rational surgical treatment is important for bilateral adrenal masses, while glucocorticoid therapies could be effective alternation for steroid replacement.